Acute Laminitis HELP

Nicole Miller

Hi, out of pure desperation I found this incredible group online. I have A 19 year old Dutch Warmblood gelding who was hit with a horrific case of acute laminitis. Initially, it wasn't too bad he was just a tad light toed and sore. X-rays showed a one degree and three degree rotation. 

Vet started him on bute, iso, aspirin and ice soaks daily for the next month. He's been diagnosed as IR and is overweight. In the last 3 days he's taken a horrific turn for the worst. Parked out, can't walk and EXTREMELY uncomfortable. He's rocked back so much it looks like he's going to sit on his hind end. He's in some serious pain :(

The vet added gabapentin and is taking new X-rays Monday.  He took a SCARY turn for the worst once I started Soaking his grass. 

He's eating Timothy and orchard only. NSC is 13.1. The soaked hay truly seemed to inflict this awful flare. I know It's supposed to reduce the sugars but for some reason my gut is certain the soaked hay is what's playing a role here. 

I'm heart broken and seeming the advice from this group for ANY help to calm this evil
Disease down. 

Thank you for reading! 

Maxine McArthur

Hi Nicole
I'm sorry to hear your gelding is going through this, but glad you found us. My role here is to give you our welcome message for new members, that details the group's philosophy and protocols. We follow a protocol of what we call DDTE: Diagnosis, Diet, Trim and Exercise (when the horse is sound enough). Each of these is explained in the welcome message below. 

In order for us to comment responsibly, we need you to fill out a case history form for your horse. You've been sent an email with instructions on doing that, but if you get stuck at all please reach out so we can help. The case history should be uploaded in the Case History Sub-group. You can also create a photo album and upload photos of his feet and also his body condition. 

You mention he is 19 and diagnosed as IR. Could you please let us know the type of test done to confirm the IR, and the conditions at the time of testing--time of day, what he ate beforehand, any exercise or trailering. We need to know the actual numbers on the test result--you can ask your vet for a copy of the lab results. Given his age, was he also tested for PPID (Equine Cushings)? If not, it would be wise to test him as soon as possible, as uncontrolled PPID can be a factor in laminitis that does not respond to dietary restrictions. 

Regarding diet--do you have hay tests?If so, please upload them to your case history folder (if in doc or pdf format) or to your photo album (if in jpg or screenshot format).  It is unlikely (but possible, of course) that soaking the hay would contribute to footsoreness. If a hay is high in ESC + starch (we look at those numbers, not NSC), even soaking may not be enough to reduce sugars for a sensitive horse. Plus, starch does not soak out, so if the hay is high in starch, soaking may not help enough. The other option you can try is the Ontario Dehy Timothy Balance Cubes; Timothy Complete Cubes in Canada; or Triple Crown Timothy Balance Forage Cubes – Naturals. These are hay cubes that are guaranteed to be below 10% ESC + starch, and are mineral balanced. You can also substitute beet pulp for some of his hay calories, bearing in mind that beet pulp is more calorie-dense.
Make sure he is getting the appropriate amount of hay, by weight--don't guess, use a scales and weigh each flake. If he is overweight, he should be getting 2% of his ideal weight or 1.5% of his current weight, whichever is greater. More details in the Diet section below. 

Trim: it would be very helpful if you could get copies of his x-rays and upload them to your photo album (the links to instructions on doing this are in the welcome message below). Often a less-than-ideal trim can contribute to hoof pain. 

Hang in there. It is very hard to watch your horse in pain, but with more information we will try to help you help him. 

And here is the welcome message. We suggest you save the message so you can refer back to it, and please follow the links in blue to more information. 


Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Nancy Kitchen

Only a member here but I know all too well how much your heart hurts.  Hang in there.

I am sorry that you are having to face this but you have found the right place for help.  It's heartbreaking to see our horses endure this pain, just remember to breathe.  This group will help you get through it.  If you work with them they will work with you and help your horse.  There are years and years of experience here to draw from.  

Best of luck to you and your horse.  

Nancy K
Smoke and Tucky
November 2018, Southeast, MA

Smoke Case History:
Smoke Photo Album:
Tucky Case History: 
Tucky Photo Album:

Eleanor Kellon, VMD


You already received a lot of information and a further resource is

In addition to his age, his breed makes it highly suspicious that PPID is at the root of this.  Request a TRH stimulation test.

Also, I can assure you that soaking the hay did NOT make him worse.

If he has had this issue smoldering for some time, cold weather (anything below 40 to 45F) could be causing his pain .
Elleanor in PA  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Joy V

Hi Nicole,

I sent you a reply to your private message that I received so check your email!  And remember to breathe.  Hang in there.


Joy and Willie (EC/IR)
Nevada County, CA - 2019
ECIR Group Moderator

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos

Nicole Miller

Thank you for their incredible response. I’m uploading his case history shortly and imaging/labs! My heart feels at ease knowing how incredibly resourceful your page is!!
Nicole Miller CA 2023

Nicole Miller

Thank you sooo much. ❤️❤️
Nicole Miller CA 2023

Nicole Miller

Thank you so much for this reply! Losing his case asap and going to get the testing done you advised! 
Nicole Miller CA 2023